PQRI: ‘We’re from the Government, and We’re Here to Help’

Finally, you have to ask yourself: How many more patients could have been treated by this practice with the time the clinicians and staff spent filling out these forms? How much more patient care could have been delivered with the added $5796.20 spent on busy work directed towards the RNs’ salaries? (Roughly, there is one RN per physician at this practice for an entire workday.)

Needless to say, this group will not be participating in PQRI in the future.

A recent AMA survey(3) of physicians who participated in the 2007 PQRI program reported that 40% received a bonus, 29% did not, and 31% still did not know if they were going to get a bonus from CMS almost a year after completing the program. More than six in 10 physicians rated the program moderately, considerably, or extremely difficult, and only 22% were able to download their PQRI feedback report. And of those who could download the report, 59% rated their satisfaction with CMS’ information and responsiveness as none to low.

The Quality

PQRI has been promoted as a tool for improving the quality of medical care. I predict that it will not improve quality, will squelch innovation, and will punish doctors who try to keep their patients’ best interests in mind, while rewarding those who are good at paperwork.

Although PQRI just started in July 2007 and there are no published analyses of outcomes, we can perhaps get a glimpse of its future outcome by looking at its sister P4P (pay for performance) program employed with hospitals. P4P in hospital care started in 2003. Its focus has been the reporting of treatment for acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia. Although it has been demonstrated that hospitals that get bonus payments will report the quality measures at a higher rate than hospitals that don’t get a bonus,(4) actual outcomes in morbidity and mortality seem to be similar between the two groups. Comparing morbidity and mortality among 105,383 AMI patients in 54 P4P hospitals and 446 control hospitals, Glickman and colleagues(5) concluded that the pay for performance program was not associated with a significant incremental improvement in quality of care or outcomes for acute myocardial infarction. Similarly, Werner and Bradlow(6) looked at whether better conformity with P4P quality measures correlated with better outcomes among hospitals participating in P4P. In other words, did the better reporting hospitals actually get better risk-adjusted mortality rates? Among those hospitals scoring in the 25th percentile compared to those scoring at the 75th percentile, there were only small differences in hospital risk-adjusted mortality rates. So from the hospital P4P studies we know that (1) giving bonuses to the hospitals that report the data increases reporting, (2) the P4P program does not improve morbidity and mortality compared with those who don’t participate in the program, and (3) among those hospitals participating in P4P, there is minimal difference in outcomes between those with good reporting and those with bad reporting.